Board of Social Services Minutes
February 10, 2014
Commissioners' Conference Room
Second Floor – County Administration Building
10 a.m. – 12 p.m.
In Attendance: Commissioner Lew Gaiter, Commissioner Steve Johnson, Commissioner Tom Donnelly, Linda Hoffmann, Neil Gluckman, Ginny Riley, Jim Drendel, Marsha Ellis, Laura Walker, Mariah Henkel, Tammy Olivas, Teresa Albohn, Danielle Styer, Ann Marie Grobarek/p>
A recording of this worksession is available at: http://larimer.org/bcc/list_worksessions.cfm
Introductions & Announcements
Commissioner Donnelly welcomed everyone and called the meeting to order.
Director Ginny Riley introduced Lexie Koznick, Policy Analyst for the Colorado Human Services Directors Association, who has done policy work for the Senate in Washington D.C. Lexie explained that she has worked with various state legislatures before. The remaining staff in attendance introduced themselves and stated their position for the listening audience.
Ginny asked the Commissioners if they had any other agenda items. Commissioner Johnson asked that we talk about the Child Welfare Allocation Committee (CWAC) and the proposed changes in Child Care Assistance Program (CCAP) requirements. Ginny indicated Jim will cover the CWAC in his presentation and she would explain the CCAP information in the legislative update.
Re-engineering of Eligibility Determination – Update on the CIA
Benefits Planning Division Manager, Marsha Ellis, explained updates in our latest process improvement initiative in eligibility determination through the Change and Innovation group, funded by the state. Mariah Henkel, Income Maintenance Manager, Tammy Olivas, Income Maintenance Manager, Terri Albohn, Income Maintenance Technician II and Danielle Styer, Income Maintenance Technician I, assisted in the presentation, which explained the following:
- How the Change and Innovation process has worked so far
- Solutions already implemented, which include a mass case load, a call center and moving two full teams to the Loveland office
- Bottlenecks in our processes identified by core teams including how long a document stays at one step in the process and whether or not there are redundancies in tasks
- Tools to increase effectiveness including an interview tool and verification matrix
- The reassignment of teams, based on individual preference, to work on one type of task, including applications, recertifications, changes/questions, and verifications
- The creation of a handbook, based on Fairfax County Department of Human Services, that will be used for training and reference
- Staff involvement is a key element of making sure tools and process improvements are relevant
- Next steps to continue the process improvement efforts for the division
Commissioner Gaiter asked if we have defined and recorded in documentation what our “widgets” are. Marsha explained that we will receive reports that define our widgets is an application that is processed, a change to a case like adding a baby, etc. Commissioner Johnson asked for clarification on what makes up a team, and it was defined as a manager, a lead worker and eight workers who cover a variety of programs. Commissioner Johnson asked about how often we use paper versus an imaged document, and Tammy responded that we will act on a hard copy if the task can be done immediately, but anything else results in the document being scanned before it is processed. Commissioner Johnson asked why the tools have to be developed because he believed CBMS was supposed to provide this information. Ginny and the team responded that the tools are necessary in order to determine what is needed for the programs that the client has specifically requested. Commissioner Johnson asked how these new processes will be measured to check on whether or not they will be successful. Marsha responded that the Change and Innovation group have provided a list of metrics for our use and gave some examples that show we have more measure than we have in the past. Commissioner Johnson responded that this will be helpful in reporting to their bosses what this means to the client. Marsha closed by explaining that we are one of three of the big ten counties that are at the handbook development stage, so volunteered to be one of the first counties in the state working on these improvements.
Trauma Informed Systems of Care
Child Welfare Division Manager, Jim Drendel, provided an explanation of Trauma Informed Systems of Care, which is a result of federal requirements for the IV-E Waiver. This will add a screening and assessment for symptoms of trauma in children and adults starting July 1, 2014 to the current assessment process for Child Welfare. Jim is a state co-chair on the committee, and provided the following information:
- The pilot will include eight counties in the State, including Larimer, Weld, El Paso, Arapahoe and four of the smaller counties
- The assessment tool selected is the Treatment Outcome Package (TOP), which is a reliable and valid tool that has 50 questions that assess a child’s trauma and behavior
- A Social Caseworker will do the screening when a case is being opened for child protection, neglect, or juvenile delinquency
- Per federal requirements, both the children and adults should be screened
- Trauma symptom results will require a referral for a mental health assessment.
- The cost of this cannot be predicted, but estimates indicate that 50-65% cases will result in referrals. 69% of our clients are not covered by Medicaid, so Jim is requesting approximately $300,000.00 to pay for the cost of the mental health assessment that would result. Treatment would cost even more.
- Touchstone will have to do assessments for children covered by Medicaid, and estimates show the number of referrals made by Child Welfare to Touchstone will increase from three or four hundred to about one thousand four hundred.
Commissioner Johnson asked if it would be helpful to know if trauma symptoms are causing behaviors, and asked if his impression was correct that Jim was in favor of this process. Jim answered that he is in favor of this process and he does think it will be helpful for the families, but he is worried about where the funding will come from to cover potential costs resulting from this assessment. Commissioner Johnson then asked if we are obligated to provide services once an assessment is done. Jim answered that there is currently no answer from the state on who is responsible for the cost of providing services if there is no open child protection issue. Linda Hoffmann, County Manager, asked if this is plugged into Objective 3 of the Safety and Well-Being Goal for Larimer County, increasing the number of children and youth in Larimer County receiving appropriate mental health or substance abuse intervention and treatment services by 15% by the end of 2018. Jim responded that Shannon Reiff, Social Caseworker Manager for the Foster and Kinship Care team, is the co-chair for that committee, and she communicates with him frequently on this objective. Jim believes this assessment tool will help us determine what is our base line for 2014 and can help us track what progress has been made.
Jim also presented updates regarding Child Welfare allocation and the committee that makes decisions regarding the formula. Jim explained the following issues:
- Reports used by the State to determine allocation amounts provide inaccurate information about our timeliness of closure, immediate response, and number of assessments (the State does not count differential response assessments, which are 80% of our cases). We are working to correct coding and ensure the reports are accurate because it impacts our incentive dollars.
- Despite the proposal Jim made that counties be able to select the year the County negotiated the IV-E Waiver as the baseline year, the State Oversight Committee for the IV-E Waiver determined only small counties could do that but the big ten had to use Fiscal Year 2013.
- There is a workload study being done by the State right now which could affect the allocation model if it is decided to include more emphasis on how much work a county does as opposed to how much money they spend.
- There is a recommendation of the subcommittee that the percentage of savings awarded be based on the number of days in foster care reduced from one year to the next by the counties. There are 11,000 days that were saved from one year to the next for the State, and Larimer saved 2600 days, so that would result in 23.6% for Larimer County.
Commissioner Johnson recommended sending a letter to the Child Welfare Allocation Committee recommending that we support the recommendation of the subcommittee. Commissioner Gaiter recommended that we copy the CCI Board in order to make them aware of concerns we have about the decisions made by the CWAC. Ginny added that adding an emphasis on workload into the current allocation model will be an uphill battle and will require an investment of time and effort in advocating for that possibility.
Jim closed by adding that we have an upcoming scheduled visit from the State of Idaho, and interest in visits from the states of Kansas and Maryland to see how we are doing Differential Response in Larimer County.
Ginny explained that about twenty bills are coming up for consideration in the new session that relate to Human Services. These are tracked by the Directors’ Association and by a monthly meeting of the CCI Health and Human Services Committee who meets monthly. The two of the most interest are as follows:
A bill is proposed that would affect the Aid to Needy Disabled (AND) program, which currently provides $175.00 per month to disabled people who are in the process of applying for Social Security benefits. This bill proposes to increase the monthly payment by $93.00 per month and provide an annual increase tied to the cost of living. The increased monthly payment of $268.00 is 28% of the federal poverty level. The initial increase is estimated to cost the State an additional 8.5 million dollars for this year. There is a significant amount of popular support for this bill, but Lexie added that the CCI Committee determined to just monitor the bill at this time.
Commissioner Johnson asked how many people we have on AND in Larimer County. Ginny estimated that we have 5% of state total 8300 people, or 415 people. Commissioner Gaiter asked if this benefit is paid with County or other money and what would that mean in terms of County funding given the 8.5 million dollar estimate. Ginny replied that 20% of the funding is County money, so that would mean approximately $75,000 to $100,000 of County funds. If the bill passes, it will go into effect August 2014. Human Services current budget would be able to pay for it for the rest of 2014, but an additional amount would be requested for the 2015 budget. Ginny added that approximately 40% of these funds are recovered as this benefit is paid back once the client is approved for Social Security benefits.
The other bill affects the Child Care Assistance Program (CCAP) and is sponsored by Representative Duran and Senators Nicholas and Kefalas. It is not yet introduced and has no fiscal note to determine how much this will cost. Ginny provided and reviewed a draft of some talking points for Commissioner Johnson to take to the next CCI Committee meeting on Friday. The points included:
- An overview of the current limitations and coverage of Larimer County’s CCAP
- The current budget and expenditures for CCAP
- The major new changes of the proposed bill:
- Pay providers at 75% of market rate
- Make anyone at 165% of poverty level or below eligible for the program
- Require counties to pay CCAP to clients in training or post-secondary education
- Set exit eligibility higher so people are eligible longer
Ginny indicated four major areas of concern, including:
- There is no fiscal note and it is not clear on where the funding will come from for these changes
- This will require changes in CHATS, the state computer system, which will cause problems in workflow and productivity
- Current participants may lose their eligibility, and there are no guidelines on how to take them off the program or acknowledgement that this may increase TANF applicants
- The bill is supposed to focus on improved quality of child care, but quality is only addressed in one provision that allows providers who have a specific certification to be paid at a higher rate, so the bill is actually more focused in increasing services, not quality of care
Commissioner Johnson commented that there will be a fiscal note because CHATS changes would require State funding but that he is not clear on what it will say about County funding. Ginny indicated that the bill states that counties have the ability to determine how many people can be served based on the amount of their allocation, and we may have to restrict the number of people we can serve. Commissioner Johnson asked if we could notify our current CCAP participants of this pending legislation and that they may lose their benefits. Ginny replied that we have never done that, and we would have to check with legal counsel to see if that was advisable. Commissioner Johnson recommended we send a press release to the paper to itemize our concerns. Linda asked if there were counties that routinely underspend. Commissioner Johnson responded that some counties just increase what they spend, and Ginny said the counties that underspend result in an amount of money that is allocated between the counties that overspend. Our overexpenditure was covered the year before last by those funds.
Lexie added that Senator Kefalas had a stakeholder meeting last week and the counties who can afford to do the provisions in the bill do them, and the intention of the bill is to make it consistent across the state. There is a conflict between the two goals of improving options for school readiness or expanding the number of families and children who can benefit from these services. The goal on Friday at CCI is really to try to reach some consensus on the biggest differences of opinion.
Client Activity Report
Ann Marie Grobarek, Business Operations Coordinator, presented an overview of the department’s client activity. Ann Marie reviewed: monthly average caseloads, program activity, complaint totals, and client follow-up survey regarding complaints from October 1, 2013 through December 31, 2013.
During the 4th Quarter:
- The Benefits Information Center took 11,494 calls and 89% were resolved on the 1st contact
- Child Support collected a total of $4,118,453
- Children, Youth and Family (Child Protection) received 1,682 referrals, 609 were assigned for assessment, with 97% of children involved with our services remaining in their homes when that was the case plan
- The Director’s office received 15 formal complaints
Ann Marie explained that the dramatic increase in BPD caseload was a result of reporting results not being available in 3rd Quarter for Medicaid applications and 4th Quarter the numbers were available and the Affordable Care Act (ACA) numbers are now being considered. Ginny added that the Affordable Care Act resulted in separate categories of Medicaid cases being collapsed into one category, so that also has impacted the total numbers for those quarters. Ann Marie explained that the BIC increase of calls was due to an increase in questions regarding Medicaid. This has increased the volume of calls so much that it has affected the number of calls that can be resolved on the 1st contact. Ginny indicated that we normally have a percentage in the 90s for that metric. Ginny also commented on the total amount collected by Child Support, indicating that at the rate of $4,118,453 we will exceed our collections from the previous year.
Commissioner Gaiter asked for clarification regarding the Child Protection numbers. 1,682 referrals were received, 609 of those referrals were assessed, and we have 1,283 open cases and assessments. Commissioner Donnelly asked about the referral to assessment ratio, and Jim responded that these numbers do not include the “friendly visitor” program that results in about 40-50 visits per month. Commissioner Gaiter asked for more information about the Professional Judgment complaints in the past quarter, and Ginny, Jim, and Ann Marie explained some of the concerns that fall under professional judgment. Commissioner Gaiter asked us to review the category for patterns, Ginny said that she reviews each complaint and has not noticed any pattern except for there being concerns about decisions made regarding visitation. We will track complaints this quarter to answer whether or not there is a trend or if there is a pattern we have noticed.
Ginny will not be at the next meeting. Deputy Director Laura Walker will report in her place. The next meeting is scheduled for May 19, 2014 from 10 a.m. to 12 p.m., in the Commissioners Conference Room.